BELLAGIO GROUP

May 31, 2007

World Health Assembly Resolution

Last week, the WHO concluded the 60th World Health Assembly, and adopted a resolution on "sharing of influenza viruses and access to vaccines and other benefits." The entire statement is available from the WHO's website here (PDF). Below, I've copied what I take to be some of the most salient points.

Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits

The Sixtieth World Health Assembly, Having considered the report on avian and pandemic influenza: developments, response and follow-up .....Stressing the need for effective and transparent international mechanisms aimed at ensuring fair and equitable sharing of benefits, including access to, and distribution of, affordable diagnostics and treatments, including vaccines, to those in need, especially in developing countries, in a timely manner;

1. URGES Member States: (1) to continue to support, strengthen and improve the WHO Global Influenza Surveillance Network and its procedures through the timely sharing of viruses or specimens with WHO Collaborating Centres, as a foundation of public health, to ensure critical risk assessment and response, and to aim to ensure and promote transparent, fair and equitable sharing of benefits arising from the generation of information, diagnostics, medicines, vaccines and other technologies; .....(3) to support WHO as appropriate in order to identify and implement mechanisms referred to in paragraph 2, subparagraph (1) [see below];

2. REQUESTS the Director-General: (1) to identify and propose, in close consultation with Member States, frameworks and mechanisms that aim to ensure fair and equitable sharing of benefits, in support of public health, among all Member States, taking strongly into consideration the specific needs of developing countries, such as, but not limited to: (a) innovative financing mechanisms to facilitate timely and affordable procurement of pandemic vaccines for and by Member States in need; (b) facilitation of acquisition by developing countries of capacity for manufacturing in-country influenza vaccine; (c) access to influenza-vaccine viruses developed by WHO Collaborating Centres for the production of vaccines by all influenza-vaccine manufacturers, particularly in developing countries; .....

(2) to establish, in close consultation with Member States, an international stockpile of vaccines for H5N1 or other influenza viruses of pandemic potential as appropriate, for use in countries in need in a timely manner and according to sound public-health principles, with transparent rules and procedures, informed by expert guidance and evidence, for operation, prioritization, release of stocks, management and oversight; .....(4) to mobilize financial, technical and other appropriate support from Member States, vaccine manufacturers, development banks, charitable organizations, private donors and others, in order to implement mechanisms that increase the equitable sharing of benefits as described in paragraph 2, subparagraphs (1), (2) and (3); .....

Over the past several months, I've grown wary of anything that looks like a "breakthrough," since it takes a great deal of cooperation from multiple actors to implement a workable solution. But there is cause for hope here.

Happily, this resolution focuses serious attention on the need for increased capacity for producing influenza vaccines. Ensuring fair and equitable access to vaccines requires more than simply distributing the resources that happen to be available as broadly as possible. Existing manufacturing technology and capacity simply won't be able to supply enough vaccine to meet global demand in the event of a pandemic. An ideal solution would enable more countries to produce vaccine locally (or regionally).

If a pandemic began tomorrow, the countries that can afford to purchase vaccine at the going market rate could easily gobble up as much vaccine as could be produced in the first 6 or 8 (or more) months of a pandemic. In the short term, I doubt there's much that can be done about this. A medium term solution would involve, as the WHO says, "facilitation of acquisition by developing countries of capacity for manufacturing in-country influenza vaccine"--that is, establishing the know-how and the physical means for producing vaccines locally. This would reduce competition for already scarce supplies and allow countries to obtain a degree of self-sufficiency.

Also of note is the WHO's mention of "innovative financing mechanisms" for the procurement of vaccines. It's not immediately clear what such mechanisms would be (probably because they haven't been fleshed out yet), but if enough energy and funding are directed at the problem, something could happen.

The tricky part, I think, will be to get different parties to agree on what sequence of steps is necessary to move forward. Indonesia's provision of a few clinical samples from H5N1 infected patients to the WHO Collaborating Center in Tokyo is a start, but as far as I know, they haven't provided samples from each new case this year. If this good will gesture turns out to be nothing more than that--a gesture, rather than an actual policy shift--it's possible that potential donors will be reluctant to take the next step.